As doctors carry increased patient loads on the institutional books, they actually have less patient time because, in the managed-care environment, they must process hundreds of patients. It falls to nurses to be the patient's principal point of contact with physicians, but they are also the point of contact between patients and hospitals. And it is the nurses--not the physicians, hospital administrators, or insurance salesmen--who are placed in the position of having to ask patients only minutes after they have undergone significant surgical procedures whether they are ready to leave the hospital (Hampshire, 2001).
Nowhere is expert nursing care more vital than in the postoperative phase of treatment of breast-cancer patients, who as a group are at risk for multiple physical, sexual, and psychological morbidities (e.g., Postoperative, 1999; Yurick, Farrar, & Anderson, 2000) and whose postoperative program must be individuated depending on whether they receive chemotherapy, radiation treatment, and/or physical therapy. Registered nurses are uniquely positioned to identify patients' needs and communicate them to physicians as appropriate and to effectively "manage the care of patients with catheters or devices for analgesia to alleviate acute postsurgical pain, pathological pain or chronic pain" pursuant to doctors' orders" (ANA, 1991).
Finances have trimmed patient access to traditional health care and the special benefits that nursing expertise can supply. The fact of downsizing RNs off of hospital floors speaks for itself as far as patient care is concerned. Research shows that low nurse staffing can result in otherwise avoidable health complications (Kovner & Gergen, 1998). In other words, the quality of patient care suffered, or the very availability of such care suffered.
Failure to protect breast-cancer-surgery patients from premature release based on health-care insurer or institutional protocols rather than patient needs ...
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